Role In Stroke Rehabilitation Research Articles

Understanding the family burden and caregiver role in stroke rehabilitation: insights from a retrospective study.

Stroke negatively impacts both patients and their families, who must face multiple changes after the onset of the disease. Family caregivers must face new problems with a possible sense of inadequacy, stress and burden. Our retrospective study aimed to assess the burden of caregivers during the rehabilitation process of patients with Stroke. This study included patients with a diagnosis of stroke and their caregiver, who attended the Day Hospital of the IRCCS Neurolesi Center "Bonino-Pulejo", Messina, Italy, between January 2018 and October 2019, using electronic recovery system data. The final sample consisted of 30 patients and their caregivers. Significant improvements were observed in patients' cognitive and mood scores, reflecting the efficacy of rehabilitation therapies. Additionally, a correlation emerged between patients' reported anxiety levels and caregivers' reported depression levels, highlighting a dynamic interaction between the emotional states of the two groups. The study highlights the intricate interplay between caregiver characteristics, patient outcomes, and family dynamics in the context of caregiving. Targeted interventions aimed at improving family resilience and coping mechanisms are crucial to optimizing the well-being of both caregivers and patients.

Awareness and Knowledge of Health Science Professionals on the Role of Speech-language Pathologists in Stroke Rehabilitation

Abstract Introduction: Stroke is a complex condition that requires various health professionals’ coordinated and effective collaboration. Although the team approach is regarded as the most successful approach to stroke rehabilitation, understanding of the potential roles and responsibilities of each health professional by other team members remains variable. As speech-language pathologists work collaboratively in a patient-focused stroke rehabilitation team, other health science professionals must be aware of their roles. To investigate health science professionals’ awareness and knowledge of the role of speech-language pathologists in the stroke rehabilitation team. Methods: A cross-sectional survey design was conducted through hybrid mode. One hundred and ninety-two students from seven different health science backgrounds including Ayurveda, Medicine, Nursing, Physiotherapy, Occupational therapy, Psychology and Dietetics participated in the present study. Results: Among the different health science groups, students from occupational therapy were found to have relatively better awareness and knowledge about the role of speech-language pathologists in stroke rehabilitation. However, perceptions about the same among other groups were variable. Conclusions: It is of utmost significance that all health science practitioners should be aware of the roles and responsibilities of each team members’ role in stroke rehabilitation which may facilitate better patient outcomes.

Assessing the level of perceived social support among community-dwelling stroke survivors using the Multidimensional Scale of Perceived Social Support

Social support has an important role in stroke rehabilitation. The Multidimensional Scale of Perceived Social Support (MSPSS) is an instrument examining the adequacy of perceived social support. However, the psychometric properties of the Chinese version of MSPSS (MSPSS-C) have not been examined in Chinese people with stroke. This study aimed at investigating the psychometric properties of the MSPSS-C, identifying the correlations between MSPSS-C scores and health-related measures of these people; and examining the differences in the levels of perceived social support between people with and without stroke in Hong Kong using a cohort of 57 community-dwelling people with stroke and 50 age-matched healthy controls. We found that the MSPSS-C subscales demonstrated excellent internal consistency, and a ceiling effect was observed for the family subscale of the MSPSS-C. The total MSPSS-C score had significant weak to moderate correlations with the scores of the concerned variables of interests. Exploratory factor analysis revealed a two-factor structure for the MSPSS-C. People with stroke had lower levels of perceived social support from friends and their significant other than those without stroke. The MSPSS-C is a valid tool for assessing perceived social support among chronic stroke survivors with moderate to very severe motor impairment.

Functional recovery outcomes following acute stroke is associated with abundance of gut microbiota related to inflammation, butyrate and secondary bile acid.

Accumulating evidence suggests that gut microbes modulate brain plasticity via the bidirectional gut-brain axis and play a role in stroke rehabilitation. However, the microbial species alterations associated with stroke and their correlation with functional outcome measures following acute stroke remain unknown. Here we measure post-stroke gut dysbiosis and how it correlates with gut permeability and cognitive functions in 12 stroke participants, 18 controls with risk factors for stroke, and 12 controls without risk factors. Stool samples were used to measure the microbiome with whole genome shotgun sequencing and leaky gut markers. We genotyped APOE status and measured diet composition and motor, cognitive, and emotional status using NIH Toolbox. We used linear regression methods to identify gut microbial associations with cognitive and emotional assessments. We did not find significance differences between the two control groups. In contrast, the bacteria populations of the Stroke group were statistically dissimilar from the control groups. Relative abundance analysis revealed notable decreases in butyrate-producing microbial taxa, secondary bile acid-producing taxa, and equol-producing taxa. The Stroke group had higher levels of the leaky gut marker alpha-1-antitrypsin in the stool than either of the groups and several taxa including Roseburia species (a butyrate producer) were negatively correlated with alpha-1-antitrypsin. Stroke participants scored lower on memory testing than those in the two control groups. Stroke participants with more Roseburia performed better on the picture vocabulary task; more Bacteroides uniformis (a butyrate producer) and less Escherichia coli (a pro-inflammatory species) reported higher levels of self-efficacy. Intakes of fiber, fruit and vegetable were lower, but sweetened beverages were higher, in the Stroke group compared with controls. Vegetable consumption was correlated with many bacterial changes among the participants, but only the species Clostridium bolteae, a pro-inflammatory species, was significantly associated with stroke. Our findings indicate that stroke is associated with a higher abundance of proinflammatory species and a lower abundance of butyrate producers and secondary bile acid producers. These altered microbial communities are associated with poorer functional performances. Future studies targeting the gut microbiome should be developed to elucidate whether its manipulation could optimize rehabilitation and boost recovery.

Nursing and Allied Health Staff Perceptions and Experiences of a Volunteer Stroke Peer Support Program: A Qualitative Study.

PurposeStroke brings about physical, cognitive, and psychosocial changes and, consequently, many stroke survivors feel underprepared for the transition from hospital to home. Nursing and allied health staff have a key role in stroke rehabilitation. Peer support programs have been found effective in supporting stroke survivors, alongside hospital staff caring for stroke patients, by providing experiential knowledge that staff are not able to provide.AimThis study explored the perceptions and experiences of nursing and allied health staff of a volunteer peer support program for stroke inpatients.MethodsThis study utilised a qualitative, evaluative case study design. This study was conducted at a public metropolitan hospital in Western Australia that had developed a stroke peer support program (SPSP) on a rehabilitation ward. A purposeful sample of nurses (n = 5) and multidisciplinary allied health staff (n = 5) were recruited from the ward where the SPSP was provided for stroke inpatients. Semi-structured, face-to-face interviews were conducted with staff participants. Verbatim transcripts from audio-recorded interviews were analysed using inductive thematic analysis.ResultsNursing and allied health staff perceived the SPSP as valuable to stroke patients’ rehabilitation and beneficial to families, volunteer peers and staff. Four themes encapsulated the findings: awareness of and involvement in the program; recognising the benefits of the program; perceived enablers and barriers of the program and suggestions for the future of the program.ConclusionNursing and allied health staff within multidisciplinary teams are cognisant of the psycho-emotional needs of stroke patients which staff are not fully able to meet. The study findings confirm volunteer peer support can provide valuable and fundamental adjunct support to address stroke patients’ unmet needs, as well as supporting staff to enhance stroke patient care.

170 Admissions to a Stroke Unit in an Irish Rehabilitation Hospital: A Review from Speech and Language Therapy

Abstract Background Communication disorders and dysphagia are debilitating sequelae associated with stroke. Speech and Language Therapy (SLT) has a pivotal role in stroke rehabilitation, and in improving outcomes. The research into dysphasia, dysphagia, and dysarthria post-stroke is extensive. In comparison, the research into cognitive-communication difficulties post-stroke is still emerging. Cognitive-communication difficulties (CCDs) are communication impairments resulting from underlying cognitive deficits due to neurological impairments1. The aim of this audit was to review SLT referrals in an Irish Stroke Rehabilitation Unit. Methods Single-centre retrospective review of all stroke admissions from January to December 2018. Communication outcomes were assessed using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM)2 a 7-point disability rating scale. Standard Bayesian statistics were employed for analysis. Results SLT received referrals for 66% (n=41) of all stroke admissions (n=62). Mean age was 68 years (SD+/-14), compared with 70 years (SD+/-14) for patients not referred. 65% were female and 35% male. Patients requiring SLT had significantly longer length of stay (p=0.0072). 83% of referrals were for communication, 12% dysphagia, and 5% inappropriate. Of communication referrals, primary diagnoses were as follows: 17.5% dysarthria (n=6), 26.5% dysphasia (n=9) and 56% CCD (n=19). Patients with dysphasia showed greater improvement in FIMFAM scores (x̄=1.3) than those with CCD (x̄=0.9) or dysarthria (x̄=0.7). Patients with CCD comprised the largest cohort who required SLT on discharge (68%). Conclusion CCDs are highly prevalent and represented the largest subtype of communication disorders in this cohort. FIMFAM scores appear useful in assessing CCDs however they display insufficient sensitivity in capturing change within this population. This audit highlights the need for further interdisciplinary research, education and training into cognitive-communication difficulties with post-stroke populations.

Nursing practice in stroke rehabilitation: Perspectives from multi-disciplinary healthcare professionals.

In this qualitative, descriptive study, we explored the status of and factors related to nursing practice for stroke rehabilitation in China, considering the perspectives of multi-disciplinary healthcare professionals. Fifteen participants were interviewed in depth, followed by field observations at three healthcare institutions. Data were analyzed using ethnographic data analysis methods. Current nursing practice for patients with stroke emerged as a cultural domain that included nine patterns: coordination of nursing, basic nursing following nursing procedures, limited rehabilitation nursing care with varied functions, therapeutic function in rehabilitation care, the importance of nurses' involvement in rehabilitation, environments making rehabilitation nursing possible, inadequate staffing for the numerous clinical nursing practices, lack of effective communication with other healthcare professionals, and lack of policies regarding rehabilitation nursing practice. Nurses' role in stroke rehabilitation must be addressed by updating nursing practice. Further, stroke team leaders must recognize the constraints faced by nurses in fulfilling their stroke-rehabilitation roles.

Effect of Arm Sling on Postural Stability in Stroke Patients

AbstractBackground: Stroke is the second leading cause of death worldwide, and is the major cause of morbidity, particularly in the middle aged and elderly population. Despite some uncertainty about their efficacy and timing, arm slings are still the most preferred treatment modality for shoulder sub-luxation in stroke patients.Aim of Study: This study was designed to determine the effect of arm sling on postural stability in stroke patients.Patients and Method: This study was conducted on forty-five patients of both sexes (30 males and 15 females) with hemi paretic stroke (in the domain of carotid system). Their ages ranged from 45-60 years, the duration of stroke ranged from 6 to 18 months. They were assigned into one group (study group). All patients were assessed on biodex balance device. Data obtained from the study group under two condi-tions, without arm sling and with arm sling. Data of overall stability index, anteroposterior stability index and mediolateral stability index were statistically analyzed and compared between the two conditions.Results: The results of the present study revealed that there was a statistically significant improvement in values of overall stability index in arm sling condition compared to without arm sling condition (p=0.0001)*. The mean difference between without and with arm sling conditions was 1.16 and the percent of change was 28.85%.Conclusion: In view of the results of this study, it's possible to conclude that there was a beneficial effect of using arm sling on postural stability in stroke patients and it may play a role in stroke rehabilitation.

Prospective clinical study of rehabilitation interventions with multisensory interactive training in patients with cerebral infarction: study protocol for a randomised controlled trial

BackgroundMultisensory interactive training has an increasingly prominent role in stroke rehabilitation. Currently, there is insufficient evidence to demonstrate its efficacy on gait improvement, upper limb and lower limb functional improvement, global motor function and cognitive improvement. A recent Cochrane review confirmed that published studies on virtual reality (VR) training have the limitations of lack of powered sample size, did not evaluate the benefits over a long-term period and lacked trial quality on cognitive function. Another systematic review also concluded that the evidence for the use of VR in gait and balance improvement is limited. This study investigates the effects of multisensory training on gait pattern, upper and lower limb biomechanics, upper limb gross and fine motor functions, and lower limb functional recovery over a medium- to long-term period.MethodsTwo hundred and twenty-four acute stroke patients will be recruited from a single centre over a period of 6 years. Participants will be randomly assigned to either conventional therapy or conventional therapy with VR training. Outcomes will be recorded at baseline, post intervention and at 3, 6 and 12 months post intervention. Primary outcome measure is gait speed. Secondary outcome measures include kinematic data of upper and lower limb motion, muscle tone, Action Research Arm Test and Short Orientation Memory Concentration Test.DiscussionThe results of this trial will provide in-depth understanding of the effect of early VR interventions on gait, upper and lower limb biomechanics and how it may relate to changes in functional outcomes and muscle tone.Trial registrationChinese Clinical Trial Registry (Registration No.: ChiCTR-IOC-15006064). Registered on 11 May 2015.

A culture of caring: how nurses promote emotional wellbeing and aid recovery following a stroke

Experiencing a stroke can significantly impact on a person's emotional wellbeing. As nurses play a key role in stroke rehabilitation, their responses to the emotional experience of stroke may be crucial to the wellbeing of the patient and their relatives. This interpretive ethnographic study involved a purposive sample of 10 cases, with each ‘case’ comprising a patient, their closest relative and the nurses who provided their care. Data were constructed through participant observation, interviews and document review. Analysis revealed that the relationships built and sustained between nurses, patients and relatives were central to creating a positive culture of caring, which promotes emotional wellbeing and aids recovery in stroke rehabilitation. The importance of this culture should be more fully acknowledged, both within nursing and the wider multi-professional rehabilitation team.

A culture of caring: how nurses promote emotional wellbeing and aid recovery following a stroke

Experiencing a stroke can significantly impact on a person's emotional wellbeing. As nurses play a key role in stroke rehabilitation, their responses to the emotional experience of stroke may be crucial to the wellbeing of the patient and their relatives. This interpretive ethnographic study involved a purposive sample of 10 cases, with each ‘case’ comprising a patient, their closest relative and the nurses who provided their care. Data were constructed through participant observation, interviews and document review. Analysis revealed that the relationships built and sustained between nurses, patients and relatives are central to creating a positive culture of caring, which promotes emotional wellbeing and aids recovery in stroke rehabilitation. The importance of this culture should be more fully acknowledged, both within nursing and the wider multiprofessional rehabilitation team.

Magnetic Resonance Diffusion Tensor Imaging in Evaluating Transcranial Magnetic Stimulation Treatment for Acute Ischemic Stroke: A Retrospective Study

Currently there is little report about the application of diffusion tensor imaging (DTI) technology to judge the prognosis of patients with cerebral apoplexy. This study was to investigate cerebral functional connection in both sides of the M1 area in patients with cerebral infarction, who were treated with transcranial magnetic stimulation (TMS), using DTI technology. Fifteen patients with cerebral infarction admitted to the hospital between February 2013 and August 2014 were enrolled for the study. The patients were treated with TMS and underwent DTI. The fractional anisotropy (FA), apparent diffusion coefficient (ADC), the relative FA value (rFA), and relative ADC values (rADC) were analyzed using paired t-test. rFA, rADC, and NIHSS of the lesion side before and after treatment were analyzed by Spearman correlation analysis. The results showed that before treatment, ADC value and FA value of the lesion side were lower than those of the contralateral healthy side with statistical significance (ADCt = 2.849, P < 0.05; FAt = 10.285, P < 0.05). Four weeks after treatment, ADC value and FA value of the lesion side were higher than those before treatment with statistical significance (ADCt = 6.206, P < 0.05; FAt = 3.788, P < 0.05). Both rFA values of pre-treatment and post-treatment showed negative correlation with NIHSS score with statistical significance (P < 0.05). In conclusion, after TMS with TDI technique, the value of FA and ADC values significantly increased compared to that of pre-treatment. It suggested that transcranial magnetic stimulation played a positive role in stroke rehabilitation.

Interventions for post-stroke disturbances of mood and emotional behaviour: recommendations from SIGN 118

David C Gillespie, Sara Joice, Maggie Lawrence, Janice Whittick Background: Stroke is a leading cause of death and disability. A high proportion of those who survive participate in programmes of rehabilitation. Clinical practice guidelines have come to play an increasingly important role in stroke rehabilitation, providing accessible summaries of the evidence for the management of specific consequences of the condition. Among the most common - and disabling - consequences of stroke are disorders of mood and emotional behaviour. Content: This article reports the development of clinical practice recommendations for post-stroke emotional disturbance for the Scottish Intercollegiate Guidelines Network (SIGN). SIGN 118 Management of Patients with Stroke: Rehabilitation, Prevention and Management of Complications and Discharge Planning was published in June 2010. Suggestions are made for ways in which the SIGN 118 recommendations for disorders of mood and emotional behaviour can be implemented in routine clinical practice. Limitations of the guidelines are also discussed. Conclusions: Although gaps in the evidence base exist, SIGN guideline 118 has an important role to play in closing the gap between what stroke multi-disciplinary teams do to promote good psychological outcomes, and which aspects of practice are supported by a robust evidence base.

The role of the community stroke rehabilitation nurse

There is strong evidence for early supported discharge (ESD) following stroke, but there is no evidence on how these services should be organized or the best models of care. ESD teams rarely include a community stroke rehabilitation nurse. A service development project was undertaken in Portsmouth Hospitals NHS Trust's community stroke rehabilitation team to identify and explore the unique contributions of community stroke rehabilitation nurses in an established ESD team. When the team was set up, the nurses had inpatient stroke rehabilitation skills, but no community experience. This novel approach, which involved taking specialist hospital nurses into the community, meant there was a steep learning curve and, unfortunately, there were no role models to support their development. During these early days, it became apparent that intensive stroke rehabilitation within an interdisciplinary ESD team required effective and timely nursing intervention, the development of skills to support interdisciplinary working and a greater understanding of the roles of all team members. Locally and nationally, questions were being asked pertaining to the nurses' role, which precipitated this project. Through a series of journal club sessions, the interdisciplinary team reviewed the evidence base of the nurse role in stroke rehabilitation. The team were able to evaluate findings against current practice. The project confirmed that the community stroke rehabilitation nurse provides a unique and fundamental role to the team that strengthens the model of interdisciplinary teamworking.

Expanding the role of the stroke nurse: a pragmatic clinical trial

This paper reports a study evaluating whether expanding a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery. Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation, although this is limited by the constraints of service organization. A pragmatic randomized controlled trial was undertaken. Patients with a diagnosis of stroke were randomized to receive continued support from a stroke nurse (n = 87) or usual care and follow-up (n = 89) after discharge from hospital. Patients were recruited from two hospitals in the north-west of England from November 1999 to April 2001. Patient dependence (Barthel Index), general health (Nottingham Health Profile), activities of living (Frenchay Activity of Living Index), depression (Beck Depression Inventory) and carer strain (Carer Strain Index) were assessed at 3 and 12 months after stroke. The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months (median difference 42.6, P = 0.012), and in particular reduced negative emotional reaction (P = 0.037) and perceived social isolation (P = 0.002). In addition, the intervention reduced carer strain at 3 months (P = 0.045), and reduced deterioration in physical dependence from 3 to 12 months (P = 0.049). The provision of continued intervention from a stroke nurse after discharge from hospital, focusing on education and support, has tangible benefits for patients and carers.

A description of the nursing role in stroke rehabilitation.

A theoretical description of the nursing role in stroke rehabilitation remains elusive in the literature. The United Kingdom strategy for health service development will increasingly require nurses from all clinical specialities to collaborate with other health care professionals and stakeholders to evaluate the services they provide. In stroke rehabilitation, an understanding of the contribution that nursing makes is essential, if that collaboration is to be effective. This paper details a study undertaken to describe the nature of the nursing role in stroke rehabilitation, and the factors that shape this role. A reflective enquiry was used to enable the collection of data grounded in the realities of clinical practice. Study participants were qualified nursing staff (n=13) working in a rehabilitation unit in the north-west of England. A total of 35 in-depth reflections were obtained for analysis. Three role categories were identified in the data: the nurse as care giver, facilitator of personal recovery and care manager. Sub-categories of nursing intervention were identified within each category, together with anticipated outcomes and contextual features that shaped the category. The results of the study were verified by a purposive sample of nursing staff from the rehabilitation unit.

Stroke patients' perceptions of hospital nursing care.

While nursing remains uncertain about the nature of its role in stroke rehabilitation, recent research by social scientists re-affirms its importance. This study explored a small number of stroke patients' perceptions of hospital nursing care in order to illuminate the meaning of the role in practice. Informants' early experiences of nursing care in general medical and care of the elderly assessment wards were dominated by having the necessary done, while nursing in the Stroke Rehabilitation Unit was characterized by a do it yourself approach. These two concepts are explored in detail and related to the existing literature, suggesting some specific areas for practice development and research.

Stroke 2: expanding the nurse's role in stroke rehabilitation.

This article, the second of two considering the nurse's role in stroke rehabilitation, focuses on potential nursing contributions in a number of areas. There is scope, particularly in the community, to develop a far greater nursing role in both the acute and the postacute phases of rehabilitation. However, nurses often have ambivalent attitudes towards rehabilitation--seeing acute care as more prestigious and important. Such attitudes are developed and reinforced in basic training which gives relatively little emphasis to chronic illness.

Mental practice and imagery: a potential role in stroke rehabilitation

Mental practice and imagery: a potential role in stroke rehabilitation

In response to: Mental practice and imagery: a potential role in stroke rehabilitation [Van Leeuwen and Inglis, &lt;I&gt;Phys Ther Rev&lt;/I&gt; 1998; 3: 47–52

In response to: Mental practice and imagery: a potential role in stroke rehabilitation [Van Leeuwen and Inglis, &lt;I&gt;Phys Ther Rev&lt;/I&gt; 1998; 3: 47–52